结构化的多专业轮次对资源有限的重症监护病房的临床结果的影响:一项回顾性研究
Hiago Sousa Bastos1, Paula De Carvalho Bacelar1, Déborah Lydia Oliveira Da Silva1
1Intensive Care Unit, Hospital Municipal Djalma Marques (HMDM), São Luís, Brazil.
Medicine
|September 3, 2025
概括
在巴西一家公立医院的重症监护室 (ICU) 进行了多专业的检查,提高了患者的安全性和结果. 尽管患者重症增加,但死亡率和机械通风持续时间在实施后下降.
科学领域:
- 危急护理医学
- 医疗服务研究
- 患者安全
背景情况:
- 在重症监护室 (ICU) 进行有效的沟通对于患者的安全和结果至关重要.
- 在高收入国家,多专业的检查清单提高了护理质量,但在低收入和中等收入国家 (LMICs) 的证据有限.
研究的目的:
- 用标准化检查清单对巴西资源有限的公共ICU的临床结果进行结构化每日多专业轮次的评估.
- 评估标准化死亡率 (SMR),侵入性机械呼吸 (IMV) 持续时间和干预后设备使用的变化.
主要方法:
- 对652名成年ICU患者进行了为期两年的回顾性观察队列研究 (2021-2022年).
- 用检查清单实施结构化多专业轮次治疗前一年和后一年的临床结果比较.
- 使用单变量测试和皮尔森相关性分析临床严重性 (SAPS 3),SMR,IMV持续时间和设备使用情况.
主要成果:
- 在干预后观察到患者疾病严重程度的显著增加 (SAPS3) (39. 4至60. 6;P=. 005).
- 干预后组的SMR (3.7至0.8;P=.001) 和IMV持续时间 (10至7天;P=.003) 显著降低.
- 设备使用,包括中央静脉导管 (CVC) 使用,与患者的敏度呈正相关性 (SAPS 3 和 CVC R=0. 662; P=. 019).
结论:
- 在资源有限的公共ICU环境中实施结构化的多专业轮次检查清单与改善的临床结果有关.
- 尽管患者重症增加,但该干预措施显示死亡率和机械呼吸持续时间有所降低.
- 需要使用多变量分析进行进一步的前性研究以确定因果关系.
相关概念视频
Acute Coronary Syndrome IV: Interprofessional Care
26
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
26
Methods of Documentation VI: Case Management Model
628
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
For example, a patient with a chronic...
628
Acute Kidney Injury V: Interprofessional Care
44
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
44
Chronic Kidney Disease III: Interprofessional Care
77
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
77
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
44
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
44
Methods of Documentation III: PIE
1.5K
Problem-intervention-evaluation (PIE) is a systematic approach to documentation used in healthcare settings for clinical decision-making and patient care planning. It is a structured approach to organizing patient data based on problems, interventions, and evaluations. Here's a breakdown of its key features and considerations:
1.5K


